PHARM Flashcards
(258 cards)
1
Q
Amantidine
A
Anti-viral
2
Q
Methamoglobinemia can be cause /exacerbated in which LA
A
Prilocaine (Citanest)
3
Q
LA metabolized both liver and blood
A
Articane / Septo
- ok for liver *
Both amide and ester
4
Q
Which antihistamine is least likely to cause drowsiness?
A
Loradadine
5
Q
Med given to Parkinsons pt? How does it work?
A
Carbidopa-levidopa ; increase Dopamine
6
Q
A1- receptors do ?
A
vasocontriction
7
Q
Benzo antidote
A
Flumazanil [Romazicon]
8
Q
APAP antidote
A
N-acetylcistine
9
Q
Epinephrine reversal agent
A
Phenoxybensamine
10
Q
Allergic to ASA, give them?
A
Plavix, APAP
11
Q
Cidal
A
Penicillin Cephlasporins Monobactams Carbapenins Flouroquinolones
Penny is Suicidal - shoot in the Head (Ceph) or stab in the neck with a pen and be lyin on the FLour by your mono ( self) on the carpet
12
Q
Static
A
Tetracyclines
Macrolides
Sulfonamides
Linkostomides
13
Q
Used for bradycardia and side effect is xerostomia
A
Atropine
14
Q
T/F. Aspirin can be give to asthmatics.
A
FALSE. DONT give Asthmatics (Sev /Reactive asthma/Nasal polyps) ASA, NSAIDs
D/t inhibition of COX pathways activating Lipooxygenase pathways , increasing Leukotrienes, causing BRONCHOSPASM
15
Q
T/F. BENZOs can be given to preggers
A
FALSE
16
Q
Meds given to recovering opiod addicts
A
Methadone
17
Q
Mechanism of action of Benzodiazepines
A
Facilitates GABA receptor binding by inc frequency of fl channel opening
18
Q
8-hr NSAID
A
Naproxen
give if pt allergic to codine
19
Q
Max epi given in cardiac pts ?
A
0.04mg
20
Q
Epi + propanolol what is the effect?
A
Hypertensive crisis - HR dec BP inc
21
Q
Length of time NSIADs will suppresses platelets
A
5-7 days
22
Q
Med given for Statis epilepticus sz
A
Diazepam or valium
23
Q
Med given for grand mal sz
A
pheytoin/dilation
24
Q
Med given for petit mal sz
A
ethosuccyimide
25
Erytrho (mycin?) side effect is
stomach upset ???
26
MoA of LA
vasocontriction
| block Na channels intracellularly
27
Azithromycin
Clarithromycin
Erythromycin
Lincomycin
attack the 50S ribosomal subunit
-
28
______: effect of a drug as a function of level of binding to its receptor
Efficacy
29
______ : maximal effect of a drug, greatest response
Intrinsic
30
_________, prevents NAG-NAM cross-linkages in cell walls.
Amoxicillin, like penicillin
31
Minocycline prevents the function of
30S ribosomal subunit.
32
Pregnant, what’s CI for pain killer?
- Opioids (no known safe level of narcotic use during pregnancy), NSAIDs, naproxen, aspirin should not be taken (increased chance of miscarriage and birth defects)
- APAP considered safe during pregnancy
33
Side effects of narcotic overdose other than respiratory depression:
coma, pin-point pupil (Mosby p. 291)
34
Systemic antifungal?
Ketoconazole, fluconazole, and clotrimazole
best absorbed from the stomach when the pH is most acidic, so antacids, H2-blockers (cimetidine, ranitidine) can inhibit their absorption
35
Methotrexate (anti-neoplastic) contraindications:
- anti-metabolite, used for tx of RA, psoriasis, life-threatening neoplastic diseases
- pregnant women → causes fetal death or teratogenic effects
- chronic liver disease, alcoholic liver disease (prolonged use may cause liver toxicity, cirrhosis)
- preexisting blood dyscrasias, such as bone marrow hypoplasia, leucopenia, anemi
36
_______: response to a drug over range of concentration
Potency
37
Pain killer in Lactating woman, CI is?
- codeine
- aspirin should be avoided since it can cause rashes or bleeding abnormalities in infants
[ APAP, ibuprofen, and naproxen considered safe for both mother and the baby]
38
Drugs generally considered incompatible/CI with breastfeeding
1. Anti-neoplastics
2. Anti-convulsants: Phenobarbital (long-acting barbiturate ex CNS stim), ethosuximide (tx of absence seizure), primidone (parent form of phenobarbital)
3. Drugs of abuse: amphetamine, cocaine, heroin
4. Cyclosporine
39
TI =
LD50/ED50
Theraputic index
40
Pt on warfarin: What blood test do you look at before extractions?
INR
41
pt has Aspirin allergy, pain killer option?
- APAP
| - avoid nsaids
42
Cross-allergy is most likely to happen with the anesthetic agents
lidocaine and mepivacaine.
43
Ester-type local anesthetics include (6):
```
benzocaine,
chloroprocaine,
cocaine,
piperocaine,
procaine
tetracaine.
```
Ester drive a benz, messes it up wiht coco but keeps it white w/ clorox; its a four seater and has a fancy exhaust pipe
44
Amide-type anesthetics include (6):
```
articaine,
bupivacaine,
lidocaine ,
mepivacaine,
prilocaine,
ropivacaine.
```
45
mechanism of action of acetylsalicylic acid (aspirin)?
Aspirin inhibits COX-1 and COX-2.
Cyclooxygenase (COX) is an enzyme involved in the synthesis of prostaglandins ( PGE2, PGF2α )
PGE2 and PGF2α mediate pain within the body.
46
target of H2 histamine receptor blockers
Parietal cells
47
Neuromuscular blockade of the phrenic nerve can be caused by extremely high doses of
streptomycin
48
Nalidixic acid is considered __________ in low concentrations and _______ in higher concentrations.
bacteriostatic ; bacteriocidal
ANTISEPTIC [quinolone] IN UTIs (gram neg) -not used anymore too many se
49
Alcohol has a synergist efffect with ?
bzdp, barbiuates
50
Augmentin:
amoxicillin and clavulanate potassium…know that it is a MRSA drug (Methicillin Resistant Staphylococcus Aureus)
51
What’s most likely to cause seizures?
hyponatremia
52
What does alpha 1 receptor do:
vasoconstrict
53
propanolol
Non-selective Beta blocker
54
albuterol
B2 agonist
55
Narrow angle glaucoma, what drug contraindicated?
anticholinergic
56
Amyl nitrate IS A
short-acting vasodilator
- for a prolonged period of time may result in methemoglobinemia
Causes of methemoglobinemia include exposure to environmental factors such as benzocaine, benzene, and nitrites.
Amyl nitrite can be used to treat angina pectoris and cyanide poisoning. Physiologic effects include dizziness, headache, decrease in blood pressure, increased heart rate, and relaxation of involuntary muscles. Overdose leads to headache, emesis, nausea, dyspnea, syncope, and hypotension.
57
Which of the following antibiotics acts upon the 50S ribosomal subunit?
Azithromycin
Clarithromycin
Erythromycin
Lincomycin
58
___________and _________ inhibit the transpeptidase enzyme.
Penicillins and cephalosporins
β-lactamase is an enzyme responsible for cleaving penicillins, making them ineffective against the bacteria.
59
Heparin functions by preventing the conversion of
prothrombin to thrombin.
60
Pen G is excreted in the _____
removed from the body primarily via secretion from the renal tubules
The half-life of pen G prior to elimination is said to be about 30 minutes.
PEN G less stable in acidic conditions ( vs PEN V)
61
A 1.8 mL carpule with 1:100,000 epinephrine yields ______ mg of epinephrine
0.018 mg
62
MAx epi in Caridac pts
two carpules may be given safely, because 0.036 mg is lower than the 0.04 mg limit.
63
_____________ is a penicillinase-resistant β-lactam similar to methicillin and is used to treat multi-drug-resistant S. aureus (MRSA) infections.
Oxacillin
Oxacillin has replaced methicillin in clinical use because of the adverse effects of methacillin.
Antibiotic-resistant strains called oxacillin-resistant Staphylococcus aureus (MRSA/ORSA) have become increasingly prevalent worldwide.
Penicillinase-resistant antibiotics include the following:
```
Oxacillin
Cloxacillin
Dicloxacillin
Nafcillin
Methicillin
```
64
How does LA block pain?
Blocking Na+ ions form entering neural axon.
this blocks the signal transduction mechanism and the brain doesnt receive the pain input. The primary ions involved in nerve transduction Na, Cl, K+. LA dnt absorb Ca or release Mag at the synapse.
65
loratidine ; Azelastine ; Ranitidine = ?
Second gen anti-histamines (cimetidine, Famotidine)
SE: HA, Fatigue ( NO sedation- no BBB crx)
MOA: H2 recept
1st gen = muscarinic / anticholinergic se
66
Histamine is produced by _____?
decarboylation of histidine
67
Histamine is secreted by ______?
Enterochromafin - like endocrine cells in the glands of the stomach
68
Histamine release is stimulated from ____?
mast cells via C5a and C3a
69
Histamine receptor stimulation from ___1___ causes ____2___ activation of adenolyate cyclase and cyclic adenosine monophospate
1. parietal cells
| 2. G-protein
70
__1_ and __2__ LA are the least myotoxic and _3__ is the most myotoxic LA.
1. Tetracaine
2. Procaine
3. Bupivicaine
Myotox = dose-dependent ; reversible >>myonecrosis ; dysregulates intracell Ca2+.
71
_______ is not inhibited by warfarin.
Factor VIII
Warfarin, an oral anticoagulant, inhibits the vitamin K-dependent synthesis of factors II (prothrombin), VII (proconvertin), IX (Christmas factor) and X (Stuart-Prower)- takes several days to take affect. Factor 8 is not inhibietd by coumadin.
72
ABx se = harily black tongue
Eyrthomycin
73
Opioids act by initiating a ______ cascade of pain inhibition and also binding to opioid receptors in the ____ and _____
descending
CNS and PNS.
74
Short duration local anaesthetics include:
Mepivacaine
| Prilocaie
75
pseudomonas aeruginosa is not resistant to which penicillins?
Pseudomonas aeruginosa is inherently resistant to all penicillins xcept:
c a t m (i) p
carbenicillin, azlocillin, ticarcillin, mezlocillin, piperacillin.
76
Tx for ghonnneria ?
Ceftriaxone (Rocephin)
77
Tx for Clamydia?
Azithromycin
Chenelle got it and her dentist put her on a zpack
78
How shld get abx prophylaxis ?
```
Cardiac [3]
- Hx of IE
- Hx of CYANOTIC congenital defects - untxd (VSD =/=)
- prosthetic valves
Immunity
```
79
Ibuprofen shld be avoided in:
- PRegger
- WArfin
- pre-exsiting ulcers
80
NSAID to give if ALL to APAP?
Ibuprofen
81
endogenous opioid peptides found in the body:
1. endomorphins,
2. endorphins
3. enkephalins
3. dynorphins
82
Precursor to APAP?
Both acetanilide and phenacetin are metabolized into acetaminophen.
Once this occurs, acetaminophen may be further metabolized by the liver into the conjugated metabolites glucuronide (A) or sulfate (B).
If high amounts of acetaminophen are ingested, then a large amount of N-Acetyl-benzoquinoneimine is formed (C). This is the toxic pathway because this compound forms a conjugate with glutathione that depletes the body’s stores of glutathione. Glutathione is integral for the normal functioning of the liver and the nitric oxide cycle. It is a vital antioxidant as well.
83
Herbal preparations that interfere with blood clotting include:
```
chamomile
garlic
ginger
ginkgo
echinacea.
```
Patients should stop taking the herbals 7 days prior to surgery.
Garlic may increase bleeding due to inhibition of platelet aggregation.
84
Astralagus is an
immunostimulant that may decrease the effectiveness of immunosuppressants.
85
_____ is an herbal anxiolytic and sedative-hypnotic. It may cause temporary mouth numbness upon the administration of a local anesthetic.
Kava-kava
86
Some of the adverse effects of taking loop diuretics include:
hearing problems, increased uric acid (which can cause gout attacks), potassium and magnesium depletion, and a rapid reduction in blood volume.
Loop diuretic ex: Furosemide
87
Acetazolamide is a ____1____. This drug is usually used for patients who experience mountain sickness and it is also used to treat ____2____.
1. carbonic anhydrase inhibitor
| 2. glaucoma
88
Abx with etoh has disulfriam-like rxn
Metronidazole ( flagyl)
A disulfiram-like drug is a drug that causes an adverse reaction to alcohol leading to nausea, vomiting, flushing, dizziness, throbbing headache, chest and abdominal discomfort, and general hangover-like symptoms among others
89
_________ is an herb that treats mild to moderate depression.
It has been known to have multiple interactions with medication like ______, sulfonamides, benzodiazepines, opioids, and more. It also decreases the plasma concentration of ___3__ and ____.
1. St. John’s Wort (CYP3A inducer)
2. tetracyclines
3. digoxin
4. warfarin
High doses may cause ataxia, drowsiness, and inebriation.
90
Some of the adverse effects of taking loop diuretics include:
hearing problems,
increased uric acid (which can cause gout attacks), potassium and magnesium depletion
rapid reduction in blood volume.
furosemide/lasix
HCTZ ( thiazide diuretic- s.e = sensitv to light, inc uric acid)
Amiloride = K+ sparing
91
Furosemide
HCTZ
Spirinolactone
Loop diruretic
Thiazide
Potassium sparing
92
Used to treat mountain sickness
Acetazolamide = carbonic anhydrase inhibitor.
Also tx for glaucoma.
Mountain sickness = above 10,000 feet >> acetazolamide to prevent dizziness and nausea,
93
Metronidazole is also an inhibitor of enzymes of _____and_____, therefore, it will increase the toxicity of other drugs such as ___2____, cholesterol-lowering medications, and __3___.
1. CYP2C9 and CYP 3A4
2. Coumadin[ warfarin]
3. lithium
Metronidazole = abx for anaerobic bact = flagyl
94
Benzodiazepines, such as Diazepam [valium] and Midazolam [versed], should not be used with individuals with _____1____ because it can increase the ___2____ and may cause blindness. An overdose of midazolam can be reversed with ____3__.
1. acute narrow-angle glaucoma
2. intraocular pressure
3. flumazenil [Romazicon]
95
Metronidazole is contraindicated in pregnancy, along with ____1_____, the ___2____, and the ___3_____.
1. chloramphenicol (broad, static/50S,
2. aminoglycosides (broad, cidal/30S, -mycins)
3. tetracyclines ( Broad, Static/30S , -cyclines)
96
T/F. Levofloxacin is OKAY to give pregnant.
FALSE.
| Levofloxacin has not been proven to be safe for use in pregnant patients. = Quinolone/
97
Abx ok to give preggers?
PEN (cidal)
| if allergic = AZITHROMYCIN (Macrolide/static)
98
Inhibition of mycolic acid synthesis is the mechanism of action of _______.
isoniazid
| TB med
99
Bacterial cell wall synthesis inhibition is the mechanism of action of beta-lactam drugs, such as _____.
penicillin
low toxicity , cheap
100
NSAIDs inhibit the COX-2 enzyme that is responsible for prostaglandin synthesis from _________ .
arachidonic acid
101
DNA-dependent RNA polymerase inhibition is the mechanism of action of _____________.
Rifampin
102
_______is an excitatory neurotransmitter in the category of neuropeptide. It plays a major role in pain perception
Substance P
103
____1____ are derived from the metabolism of arachidonic acid, but are produced by the _____2___ enzyme pathway. NSAIDs do not work on this pathway.
1. Leukotrienes
| 2. lipo-oxygenase
104
Nme a few CONTRAINDICATIONS for the use of ibuprofen?
1. Warfarin - ibuprofen = NSAID and effects platelet fxn
2. 1st trimester of pregnancy ( defect, HTN, Miscarraige)
3. Stomach ulcer ( irritates gastric ining)
105
properties of amide local anesthetics (LAs):
- LIVER metabolism
- WAter soluble
- affected by acidity of local tissue
- affect somenerve fibers more than others
- contain preservatives to inc shlef life
106
________ is another neuropeptide that has potent vasodilator effects. It is created by proteolytic enzymes in response to pain and works locally to dilate arterioles.
Bradykinin
107
The antituberculosis drugs combination therapy is :
Isoniazid, Rifampin, Rifampin, Pyrazinamide, and Rifabutin
108
The t 1/2 for penicillin G and V is about _____ because of rapid excretion by the kidney.
0.5 hours
109
________ are broad-spectrum drugs and have about 10% cross-allergenicity with penicillins.
Cephalosporins
110
Nitric oxide is a transmitter that is released by ___1____ cells and has many diverse functions in the body. One of them is to act as an inflammatory mediator
1. endothelial
but it is not impacted directly by NSAIDs
111
The elimination half-life of __1____ is short because of rapid excretion by the kidney, 90% of which is by tubular secretion.
1. penicillins
Very little of penicillins get metabolized.
112
What is the maximum number of 1.8 mL carpules of 2% Lidocaine HCl + Epinephrine 1:100,000 that can be administered for a healthy 18-year-old 50 kg male?
9.7 carpules
REcc dose is 7mg/kg
2% concentration = 20 mg/mL
20 mg/mL * 1.8 mL/carpule = 36 mg/carpule
There are 36 mg of lidocaine per carpule.
7 mg/kg * 50 kg = 350 mg
The maximum recommended dosage of licaine for a healthy 50 kg patient is 350 mg.
350 mg * (1 carpule/36 mg) = 350/36 = 9.7 carpules
9.7 is the maximum recommended number of carpules this patient should receive.
113
Metronidazole is limited to __1___ and is ____2____. It is contraindicated in ___3____ and __4__.
1. anaerobes
2. antiparasitic
3. pregnancy
4. alcohol
114
___1_____ is an example of a fluoroquinolone and is used for some sensitive organisms such as E. coli, Neisseria gonorrhoeae, Mycoplasma pneumoniae, and Haemophilus influenzae.
1. Ciprofloxacin
115
Cidal or Static? Ionizing Radition
CIDAL
| Ionizing radiation kills bacterial cells by disrupting their DNA and is a bacteriocidal method.
116
Cidal or Static? Dessication
Static
Desiccation involves extreme drying or dehydration and is a bacteriostatic method. Certain bacterial species with capsules may take a longer amount of time to be affected, while viruses and endospores may be unaffected by this technique.
117
Ester are metabolized by ______ in the ______.
pseudocholinesterase ; plasma
Ester drives a white BENZ a, messes it up with COco but keeps it white w/ clorox; its a TETRA seater and has a fancy exhaust PIPE
amiides
118
Safest LA to use in children
Lido ( amiides)
Bupivicaine ( marcaine) IS NOT SAFE in kids
pka= 8.1
119
LA that cause the least amt of vasodilation?
Mepivacaine (carbocaine,polocaine)
120
LA that is a vasoconstrictor
cocaine
121
Shortest duration LA
Septocaine
122
LA m.o.a
sodum channel blocker of neuron - sucess if 3 consective nodes of ranvier are blocked
only non-ionized form can diffuse thru hydrophobic membrane
Less effective in acdic (ie inflammed infxn tissue)
123
Longest duration LA
Bupivacaine ( Marcaine)
124
ADV of Midazolam (Versed) to Diazepam (Valium)
- Less incident of thrombophelbits
-SHorter elimination t1/2 life
NO significant active metabs
125
The clinical activity of a singel IV dose of Valium ( 10mg) is most dependent on?
Hepatic biotransformation
126
alpha 1 receptors cause what reaction
Vasoconstriction
INC HR and BP
CI in cardiac dz and hyperthyroid
a1 agonist = hemostatic agents ( retraction cords)
127
methylphenidate aka
Ritalin
ADHA durg ( adhd boy>girls)
blocks reuptake of NE and Dopamine
128
Amphetmine
Aderrall -indirect sympathomemetic (causing release of dopamine and NE may blk uptake)
can induce anx ; insomnia; inc HR excitabily
129
parzosin lowers bp by
smooth muslce relaxation of vasculature
130
Epi + propranolol results in
```
INC BP + DEC HR = DDI
alpha 1 ( vasoconsriction inc BP-> relfex brady)
```
propranolol is a nonselective BB ( blocks b1 and b2 --> leavinf unopposed a1
Mild case -HPN ; Sev case = maligant HTN
131
Beta blocker med ok to use wiht epi?
Metoprolol - ( selective b1 blckr)
132
The drug classes to tx angina
propranolol; ca chanel blk ; Nitro
133
Does propanolol alter ionic movement?
No
134
Role of epi ( vasoconstrictor) in LA
1. Prolong numbness
2. REduce tox
3. PRomote hemostasis
* counteracts vasodil of LA)
135
Max epi for ASA1
0.2mg
136
Mepivicaine Pka
7.6
lower = faster onset ( faster to non-ionized form = faster to crx membrane= onset)
137
AMx epi for cardiac
0.04mg/kg
138
Max lido w/o epi
4.4mg/kg
139
Max lido w/epi
7mg/kg
140
Adverse effects of metronidazole include a __1__ taste and ____2____.
1. metallic
| 2. oral candidiasis
141
Adverse effects of tetracyclines include
tooth staining, liver toxicity during pregnancy, and photosensitivity.
142
Bone turnover is INCREASED by the ____ activity, which increases osteoclast action.
RANKL
143
The body’s inflammatory response due to tissue injury is mediated by
Histamine, prostaglandins and leukotrienes
144
______ does have opioidergic and monoaminergic activity but no known NMDA-receptor activity. ______ is considered a weak opioid. It is unique in its properties for causing reuptake inhibition of both _______ and ______, leading to their accumulation, in dorsal horn spinal synapses.
Tramadol
Tramadol
5HT and norepinephrine
145
Diltiazem [cardezim] is a _____inhibitor, and would result in decreased metabolism of hepatically-modified opioids.
CYP3A
| anti-hypertensive & CCB
It can treat high blood pressure and chest pain (angina).
146
Tx for petit mal sz
Ethosuximide
147
Lido pka
7.8
also prilocaine and speto = 7.8
148
Diazepam CI
Preggers ; Myesthenia GRavis, Acute narrow anlge glaucoma, ASTHMA
149
Tx for staticus epilepticus sz
Diazepam ( valium)
if given IV least likely to cause resp depress
150
Tx for grand mal sz
Dilantin
151
Erythromycin may interact with many medications, including
theophylline, carbamazepine, cyclosporin, tacrolimus, warfarin, digoxin, terfenadine, astemizole, cisapride, lovastatin, triazolam, and disopyramide
152
Metronidazole (Flagyl) interacts with
Antabuse, anticoagulants, Dilantin, Hismanal, Lithobid, Phenobarbital, Tagamet, and vitamins.
153
what can induce sz?
Hyponatrimia
154
MEthyldopa, clonidine, NE, phenylepherine Epinepherine are all
indirect sympathomemetics
155
T/F. AntiHistamines can be used for motion sickness
TRUE
156
Epinepherine reversal agent?
Alpha adrenoceptor blockers, like phenoxybenzamine inhibit the vasoconstrictor effect but not the vasodilator effect of epinephrine = low BP
157
Salivary secretion increases with use of :
Pilocarpine,
| Neostigmine (cholinergic agonists)
158
Ephedrine, guanethidine, cocaine, amphetamine are all
indirect sympaths
159
Tx of coise for adrenergically induced arrythmya is
propanolol
160
Salivary secretion DECREASES with use of:
atropine and
| scopolamine (anti-cholinergics)
161
Acetylcholine is the chief neurotransmitter of the _____________, the part of the autonomic nervous system (a branch of the peripheral nervous system) that contracts smooth muscles, dilates blood vessels, increases bodily secretions, and slows heart rate.
parasympathetic nervous system
CHOLINERGICS = REST & DIGEST
slow heart, constrict pupils, stimulate GI smooth musc, stim sweat, saliva,
162
List of cholingerics
Acetylcholine
Neostigmine
Pilocarpine
163
___________: Acetylcholinesterase inhibitor, doesn’t penetrate BBB, tx of M. gravis
Neostigmine
164
Because it enhances the transmission of acetylcholine signals in the brain and can cross the blood–brain barrier, _______________ salicylate is used to treat anticholinergic poisoning caused by overdoses of atropine, scopolamine and other anticholinergic drugs. It is also used to reverse neuromuscular blocking drugs.
physostigmine
165
______________: used for atropine, scopolamine overdose, tx of glaucoma, acetylcholinesterase
Physostigmine
166
T/F. Atropine is a Muscarinic antagonist (anticholinergic), antidote for organophosphates and insecticides
TRUE
167
Atropine poisoning tx:
physostigmine
168
what meds to decrease saliva?
atropine, scopolamine, Pilocarpine, neostigmine
169
For a Xerostomic pt, give
pilocarpine or Cevimeline
170
If patient has xerostomia what wont you give?
Atropine - anticholinergic
171
What drug does not cause miosis [pupil constriction] of the eyes?
atropine anticholinergic ( opposite of rest & digest = pupil dilation ( fight or flight)]
172
nontoxic side effects of pilocarpine are:
excess sweating and salivation, bronchospasm
IN TOXIC DOSE =
173
________: Muscarinic agonist, tx for glaucoma and xerostomia
Pilocarpine
174
Belladonna is a
anti-cholinergic
Belladonna is a plant. The leaf and root are used to make medicine. The name "belladonna" means "beautiful lady," and was chosen because of a risky practice in Italy. The belladonna berry juice was used historically in Italy to enlarge the pupils of women, giving them a striking appearance.
175
___________ is used to treat glaucoma by lowering pressure inside the eye.
Physostigmine
ophthalmic reduces pressure in the eye by increasing the amount of fluid that drains from the eye. Physostigmine ophthalmic also causes the pupil to become smaller and reduces its response to light or dark conditions.
176
_______ is a Muscarinic antagonist (anticholinergic), antidote for organophosphates and insecticides
Atropine
177
_____ injection is used to treat a muscle disease called myasthenia gravis.
Neostigmine
178
Glycopyrrolate effect?
reduce salivary secretion, as well as the acidity of gastric secretion.
(is a muscarinic anticholinergic),
179
What is the antidote for pilocarpine?
Atropine
180
Which of the following groups of drugs is contraindicated for patients who have glaucoma?
Anticholinergic
| increases intraocular pressure
181
Cholinergics : Rest and digest as
| ___________ : Fight or Flight
Catecholamines = made by adrenal glands,
| Fight or flight = Dopamine, E/NE aka adrenaline
182
____________ is anti-cholinergic (anti-muscarinic), relieve cramps or spasms of the stomach, intestines, and bladder.
Propantheline bromide (pro-Banthine)
183
A patient has a deficiency in acetyhcholinesterase. After giving her this drug, action is prolonged.
d-tubocurarine (inhibits acetylcholine receptor = weakness of skeletal
184
Administration of succinylcholine to patient deficient in serum cholinesterase would casue?
c. prolonged apnea
185
Only LA that is a vasoconstrictor?
Cocaine
186
Pt taking narcotic for long term what causes:
headache due to increase intracranial pressure
187
_______ competively inhibits DOPA decarboxylase (which causes a decrease in dopamine and NE/EPI). Its an anti-hypertensive, acts on A2 adrenergic as well.
Methyldopa
188
Theraputic Index LD/ED is a measure of :
safety of drug
189
_____ response to a drug over a given range of concentrations
potency
| Potent = depend on dose of drug-less mg for same efficacy has more potency
190
How is bioavailability measured?
How much drug is absorbed in the circulation
Blood to urine ratio
191
what determines the frequency of dosing
Elimination rate of a drug =HALF LIFE
192
Most important determinant of drug dose is
POTENCY of drug.
193
"intrinsic" and "receptors" refer to
efficacy
EFFICACY = NUMBER OF RECEPTORS that must be ACTIVATED to yield maximal response. Higher efficacy = activates less receptors to produce this response.
194
____1____ effect of a drug -efficacy is the max effect of the drug. Max effect is also called ___2___
1. efficacy
| 2. intrinsic activity. (antagonists are not efficient/no intrinsic activity)
195
**in the Tufts packet—“Drug A had greater efficacy than drug B, so Drug A” is ...
is capable of producing a greater maximum effect than drug B.
196
The maximal or "ceiling" effect of a drug is also correctly referred to as the drug's
efficacy
197
T/F. Valium causes orofacial clefting
FALSE.
DOES NOT!
198
Which of the benzodiazepine you don’t give to seniors?
Long acting one (like diazepam)
| Short to intermediate-acting benzodiazepines are preferred in the elderly such as oxazepam and midazolam (versed).
199
Diazepam action =
work by increasing the effect of a brain chemical called GABA (gamma amino butyric acid)
= antianxiety and anticonvulsant ( can be hypnotic)
200
Benzos are great for dentistry due to an action of-
amnesia and little memory of the event.
201
Drug used to tx OCD is
Xanax-Alprazolam but does not include depression— OCD, anx, panic disorder
202
Best benzo for iv sedation =
MIDAZOLAM (versed)
203
What does IV Midazolam do?
Amnesia
204
Benzodiazepines: ones not metabolized by the liver (safe to use in liver failure)
Lorazepam ( ativan)
Oxazepam
Temazepam
205
Which drug best reverses the effect of benzodiazepines?
Flumazenil (Romazicon): Benzodiazepine antagonist ; competive GABA receptor.
Helped Benzo Flu away
206
contraindication of lorazepam:
preggers
207
Which barbiturates MOST readily penetrates the blood-brain barrier?
Thiopental
| rapid-onset short ultra acting barbiturate(IV) for general anesthesia - for desenation
208
______ is a non-benzodiazpine hypnotic, used for insomnia
Ambien ( Zolpidem)
Not benzo but anticonvulsant and muscle relaxant also reversed by Flumazenil [Romazicon] just like Benzos...potentiates GABA receptors...short half life...negative se: hallucinations and amnesia
209
A patient's early recovery from an ultrashort-acting barbiturate is related primarily to
redistribution
210
Chief mechanism by which the body metabolizes short-acting barbiturates is?
hydroxylation and oxidation.
211
Which Tryciclic drug used for iv sedation is ok for preggers/breast feeders?
Promethazine
212
________ = Psychotropic w. anxiolytic; low CNS depression, low psychomotor skill impairment
Buspirone
***Buspar—different from benzodiazepines because it does NOT cause, CNS depression, muscle relaxant, or anti-convulsant!!!!!** UNIQUE!!! Anxiolytic and antidepressant
213
TCA mechanism of action:
inhibit reuptake of NE and 5-HT (serotonin)
214
do not give which medication to lactating female?
Codiene and tetracycline
215
Know drugs used for conscious sedation?
SSRIs/BDZ
| { Diazepam and Prozac(fluoexitine) }
216
Most common psychological problem in elderly?
Depression
217
Prozac - acts on
serotonin ( SSRI)
218
Smoking cessation drug in pt with hx of depression?
Zyban Bupropion/Wellbutrin
Wellbutrin can treat depression and help people quit smoking. It can also prevent depression caused by seasonal affective disorder (SAD).
219
What catecholamine do tricyclic antidepressants affect?
serotonin
220
____________= most common tricyclic antidepressant, inhibits reuptake of NE and Serotonin
Amitrriptyline
221
St. John’s Wart is a hebral used to treat
Depression
can also reduce the effectiveness of Drugs that suppress the immune system ( txp drugs - Humira,Prograf ect)
222
How do Phenothiazines work?
1. Block DA receptors
2. Act on the extrapyramidal pathway
se: Tardive dyskinesia
223
lithium is used for?
Manic phase of bipolar disorder
224
Strongest synthetic longacting corticosteroid =
dexamethasone
225
Onset of action of antipsychotic is:
5-6 days
226
GI concern with corticosteroids:
Ulcers.
Long term effect = osteoporosis/hyperglycemia/immunosupp
227
Contraindation use of corticosteroids:
diabetes
(also: HIV, TB, CADIDIASIS | Aspirin)
corticosteroids cause peptic ulcers and aspirin worsens it by increasing the risk of bleeding
228
What catecholamine does Phenothiazine (antipsychotic) affect?
Dopamine
229
Critical dose of steroids for adrenal insufficiency
- 20 mg of cortisone or its equivalent
| 20 mg x 2 wks in the last 2 years
230
which antibiotic is antimicrobial and anticollagenlyctic:
doxycycline
once per day dosing ( + minocycline)
231
mechanism of action of pen is closely related to ?
keflex ( cephalaxin )
232
Abx tx for Cysts-why doesn’t penicillin work well?
b/c can’t penetrate cyst barrier
233
ABx rx if pen allergy
clarithromycin 500mg
234
AMOX/PEN AND METHOTREXANE: DON’T MIX!!
AMOX AND METHOTREXANE: DON’T MIX!!
amox/pen dec elim -> inc risk of tox ---> sz
reversal = leukovorin ( folinic acid)
235
tetracycline mechanism of action :
protein synthesis inhibitor (30s) = static
Do not take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking tetracycline. Antacids and milk reduce theabsorption of tetracyclines
236
antibiotic used in perio :
Metronidazole
(moa= fungal protozoa disrupt)
Metronidazole is commonly prescribed in NUG; metronidazole is CI in pts on alcohol --> disulfiram type of rxn and has red urine
237
#1 side-effect of erythromycin is?
stomach upset.
238
aminoglycosides ae:
oto toxicity and nepho toxicity
239
Tx of MRSA
vancomycin
240
***OD Methotrexate—give
LEUCOVORIN
241
Alkalizing anti-cancer drug called procarbazine causes
HEPATOXITY
242
```
QUESTION: Condition that DOES NOT require antibiotic prophylaxis:
o Prosthetic heart valve
o Rheumatic heart valve
o Congenital heart formations
o Cardiac pacemaker
```
o Cardiac pacemaker
243
Premedicate these conditions:
artificial heart valve,
previous IE,
congenital heart (valvular/cyanotic) defect,
( HEART + Immunity)
244
For pts with heart disease or multiple sclerosis what LA to give?
mepivicaine without epiniphrine
| Epi CI in these pts
245
Pt taking MAO inhibitors what you CAN NOT give him:
epinephrine
246
Local anesthetics containing EPI are contraindicated in patients taking
MAO inhibitors.
247
best LA to use w/o vasoconstrictor
mepivicane (carbo)
248
Levonordefrin is added to certain cartridges containing mepivacaine. The desired effect of levonordefrin is due to what pharmacologic effect?
VASOCONSTRICTION
| Stimulation of α-adrenergic receptors
249
s/s of *Cocaine OD—
mydriasis
250
s/s of *Opiate OD—
pinpoint pupil miosis
251
What do you give IV for ventricular arrhythmia?
Lidocaine
Lidocaine administered intravenously has been highly effective in terminating ventricular premature beats and ventricular tachycardia occurring during general surgery, during and after cardiac surgery, following acute myocardial infarction, and in the course of digitalis intoxication.
252
Which pair of anesthetics is most likely to cause cross allergy?
1. Lidocaine and mepivocaine
253
How much epi for a cardio pt?
0.04mg
254
MAXIMUM allowable dose of 2% lidocaine with 1: 100,000 EPI for adult and child?
```
7mg/kg = adult’s
4.4mg/Kg = kids
```
255
IAN given to kid - what teeth are affected?
All mandibular teeth are numb ( numb for 3hrs)
256
Excretion of an acidic drug will be enhanced if the patient is given_______?
Sodium bicarbonate
257
What is the mechanism of local anesthetics? intracellularly
Blocks Na channels
258
For a patient with myasthenia gravis, which of the following medications is acceptable?
A- Erythromycin
B- Clarithromycin
C- Imipenem
D- Penicillin
D Penicllin is okay to give.
| Macrolides (Azithro/Erythro) are known to exacerbate MG symptoms
